Reducing Secondary Diagnostic Delay Through the Breast Clinical Reporting and Data System

In the clinical management of breast cancer, the "diagnostic window" is a determinant of survival. For oncology clinicians in high-income countries, this window is often managed through high-resolution imaging like mammography. However, in low- and middle-income countries, clinicians face a starkly different reality: a median tumor size of 3.5 cm upon discovery and diagnosis and a late-stage presentation rate of up to 60%. While patient-led "primary delays" are a known hurdle, the "secondary delay"—the time lost between the first clinical consultation and a definitive diagnosis—remains a critical area where the medical community must take responsibility.

The BCRADS-2 study introduces a systemic solution to this health care bottleneck. By moving away from subjective assessments, the Breast Clinical Reporting and Data System (BC-RADS) provides a validated, objective scoring framework that integrates high-impact history—such as BRCA status and prior radiation—with specific clinical markers like skin ulceration or lump fixation.

In this interview with CancerNetwor®, Soumen Das, MBBS, MS, FACS, founder and director of the Institute of Breast Diseases, Kolkata, and head of the Department of Surgical Oncology at Netaji Subhas Chandra Bose Cancer Hospital, discusses how this simple, low-cost model achieved a 93.2% sensitivity and 88.7% specificity in a prospective trial. He explains how standardizing the clinical reporting flow can empower every level of the healthcare workforce—from rural health workers to primary care physicians—to make rapid, evidence-aligned triage decisions that reduce diagnostic delays and shift the curve toward early-stage detection.

Transcript:

In our low-and middle-income countries, most of the cancers are palpable cancer. We have a disease that is either stage III or stage IV. So, WHO has given a guideline where, if we can detect more than 60% of our patients in stage I and stage II, the outcome changes. We know the stage-wise outcome and the mortality varies. If I get a patient in stage I or stage II, the chance of cure is high in comparison to a patient who is being diagnosed in stage III or stage IV. The whole idea of the BCRADS-2 study is to diagnose a cancer at an early stage.

We conducted 1 study to see the delays in the breast cancer diagnosis. The primary delay is when I feel a lump and I go to a doctor. This window is called primary delay, and it is the patient who is responsible for this. There is a secondary delay where the primary care physician sees the patient and ultimately the diagnosis is done, and this responsibility is not with the patient [anymore]. This responsibility goes to the primary care physician. In our study, we could see that the primary delay, as well as the secondary delay, both are equally responsible for our patients to be diagnosed at a later stage. What we thought of is that we need to develop an objective criterion by which we can bring down the secondary delay by a significant extent. Now, with this BCRADS-2 study, the clinician who is seeing the patient for the first time, he or she has an objective criterion based on which the diagnosis of breast cancer is not getting delayed. With this, we can bring down the secondary delay by a significant extent.

Reference

Das S, Paul R, Mandal TK, et al. Community-integrated early breast cancer detection in LMICs using BC-RADS: the breast clinical reporting and data system (BCRADS-2 Implementation Study). Accessed January 27, 2026.